"*" indicates required fields Firm InfoFirm Name* Contact Name* Firm Address Phone Number*Email Address* HiddenInfo BreakAttorneys and EmployeesRepeaterLawyer Name First Last Florida Bar Number Number of Years With the FirmBoard Certified? Yes No Add LawyerRemove LawyerNumber of Non-Lawyer Employees on the Firm*HiddenPractice/Attorney breakPractice InfoCurrently Insured* Yes No If Yes, what is the Retroactive Date? Own a Title Company?* Yes No Limits of Liability per Claim/Total Limit* $100,000/$300,000 $250,000/$500,000 $500,000/$1,000,000 $1,000,000/$1,000,000 Other Deductible* $1,000 (available for $100,000/$300,000 policies only) $2,500 $5,000 $10,000 Percentage of Practice In Dade, Broward & Palm Beach Counties Percentage of Practice Out of State HiddenPractice Info BreakClaims/Discipline InformationNumber of Reported Incidents and/or Claims in Last 5 Years Number of Disciplinary Proceedings Before Any Bar within the Past 5 YearsThree Major Areas of Practice and Percentages1. Area of Practice1. Percentage2. Area of Practice (Optional)2. Percentage (Optional)3. Area of Practice (Optional)3. Percentage (Optional)HiddenClaims/Discipline Information Break Δ
